Sustained hypotension during shoulder arthroscopy is associated with postoperative nausea and vomiting

by Rili Yu, Xia Yang, Juan Chen, Fan Zhang

Background

Postoperative nausea and vomiting (PONV) is a common and distressing complication following shoulder arthroscopy. Although hypotension is known to trigger nausea, the specific association between sustained intraoperative hypotension (SIH) during shoulder arthroscopic surgery and PONV has not been well characterized. This retrospective study aimed to investigate whether SIH is independently associated with PONV.

Methods

We retrospectively analyzed data from 306 patients who underwent shoulder arthroscopy between March 2018 and January 2024. SIH was defined as a ≥ 20% decrease in mean arterial pressure (MAP) from baseline persisting for at least 60 minutes during the controlled hypotension phase. Univariate logistic regression analysis and multivariate exact logistic regression analysis were performed to identify factors associated with the occurrence of PONV. PONV severity was compared between the SIH and non-SIH groups using the chi-square test.

Results

PONV occurred in 96 patients (31.37%). Univariate logistic regression analysis revealed that females, smoking, history of motion sickness and/or PONV, and SIH were related to the occurrence of PONV (all p < 0.05). Multivariate logistic regression analysis revealed that females (adjusted OR: 3.966, 95% CI: 2.149–7.317, p < 0.001), smoking (adjusted OR: 0.232, 95% CI: 0.107–0.501, p < 0.001), history of motion sickness and/or PONV (adjusted OR: 32.393, 95% CI: 3.801–276.051, p = 0.001), and SIH (adjusted OR: 2.198, 95% CI: 1.289–3.749, p = 0.004) were independently associated with the occurrence of PONV. Additionally, patients with SIH exhibited significantly higher severity grades for both nausea (p = 0.002) and vomiting (p = 0.007).

Conclusion

SIH due to controlled hypotension during shoulder arthroscopic surgery was independently associated with PONV. SIH may serve as a clinically relevant predictor for PONV.

The clinical characteristics and risk factors of steroid-induced ocular hypertension following pars plana vitrectomy

by Shuanghong Jiang, Hongxia Yang, Ting Chen, Zhenyu Ji, Xixi Yan

Objective

This study aimed to assess the incidence and risk factors for the development of steroid-induced ocular hypertension (SIOH) following 23-gauge (23G) pars plana vitrectomy.

Methods

The clinical data of patients treated with 23G vitrectomy from January 2019 to March 2022 were reviewed retrospectively. The incidence and characteristics of SIOH post-operatively and treatment provided were recorded. The clinical risk factors for developing SIOH were analyzed using logistic regression analysis.

Results

Among the 540 eligible patients, 111 (20.56%) cases developed SIOH. The majority (83.78%) of the SIOH cases developed between the third and seventh day postoperatively. Among these cases, 65 (58.56%) patients had an intraoperative pressure (IOP) of 30 mmHg or higher, and 31 (27.9%) had an IOP of 40 mmHg or higher. The IOP of all SIOH patients returned to normal within 1 month following the discontinuation of steroid and IOP-lowering medicine treatment. The independent risk factors for SIOH (IOP ≥ 23 mmHg) were myopia (odds ratio (OR) 5.22) and silicone oil filling (OR 8.20). For severe SIOH (IOP ≥ 30 mmHg) myopia and silicone oil filling were also identified as risk factors with an OR of 3.23 and 12.86, respectively. After adjusting the steroid administration pattern, the incidence of all SIOH and severe SIOH decreased to 17.11% and 9.14%, respectively.

Conclusions

Myopia and silicone oil filling were identified as potential independent risk factors for the development of SIOH after vitrectomy. A shorter topical steroid therapy was associated with a lower incidence of SIOH particularly in high-risk patients.